Rhinosporidiosis is a rare chronic granulomatous
infection that usually manifests as vascular friable polyps arising from the
nasal mucosa or external structures of the eyes caused by Rhinosporidium
seeberi, recognized as water mold-related fungus.

We report a case of rhinosporidiosis in a twenty
six years old male presenting at the Department of ENT, Jinnah Postgraduate
Medical Centre Karachi with the complaints of blockage of nose and bleeding
from nose for four months. EUA and endoscopy revealed polypoid mass in
nasopharynx and nose. CT scan revealed a soft tissue mass in the nasopharynx
with the impression of a polyp or a neoplasm. Histological examination
revealed variable sized cysts with a chitinous wall consistent with
rhinosporidiosis.

Rhinosporidiosis is a chronic granulomatous
infection that usually manifests as vascular friable polyps arising from the
nasal mucosa or external structures of the eyes. It was initially described by
Seeber, in 1900 in an individual from Argentina

1. The
etiological agent of rhinosporidiosis is Rhinosporidium seeberi, that has
never been cultured. R. seeberi, traditionally have been believed to be a
fungus. Recent 18s ribosomal ribonucleic acid (rRNA) gene analysis has placed
R. seeberi into a novel group of aquatic parasites2.
Most persons with rhinosporidiosis have had bathing or working exposure to
stagnant water1. It is endemic in India, Srilanka,
Bangladesh with only sporadic occurrence in United States3.
It is uncommon in Pakistan4. Thought to be a zoonotic
organism because it is seen in cattle, horse and mules5.It
is clinically characterized by formation of papillomatous or polypoid mass4.

CASE REPORT

We report a case of rhinosporidiosis, a rare
infectious disease seen in the Department of Pathology, Basic Medical Sciences
Institute of J.P.M.C. This is the second such case seen in the last 10 years
in our Department.

A twenty six years old male presented at the
Department of ENT, JPMC with complaint of bleeding from nose for four months,
and blockage of nose . EUA and endoscopy revealed polypoid mass in nose and
nasopharynx. CT scan of paranasal sinuses revealed a soft tissue mass in the
nasopharynx, measuring 4 x 3 cm related to left side. Left maxillary,
sphenoidal and frontal sinuses were clear. Both orbits were normal in limits.
Bone structure was normal. Rigid nasal endoscopy and biopsy of the mass was
done.

Rhinosporidiosis is a chronic granulomatous
infectious disease, characterized by hyperplastic polypoid lesions of the
mucous membrane, predominantly nasal but, rarely of the skin and viscera

5.

The condition was first observed by Professor
Malbren, of Buenos Aires, in 1892. In 1896 Seeber re-examined this material
and included it in his thesis for the M.D. degree, but failed to name it.
Belou in 1903, designated the organism as Coccidium seeberi, though Wernicke
apparently had suggested the name in 1900. The first case recognized in India
was by O’Kinealyi in 1894. Minchin and Fantham in 1905 reviewed the material
of O’Kinealyi’s case and called the organism Rhinosporidium kinealyi, being
unaware of the fact that it had earlier been named Coccidium seeberi. Ashworth
after a study of Rhinosporidium, proved that it was not a sporozoa, but
belonged to the group phycomycetes in the sub-order of Chytridineae, and
called it Rhinosporidium seeberi, which has become its accepted name

6.
Since then the microbe has been considered a fungus by most microbiologists,
although its taxonomy has been debated. Using consensus polymerase chain
reaction (PCR) approach, Fredrick and colleagues amplified a portion of the R.
seeberi 18SrRNA gene directly from infected tissue. Analysis of the aligned
sequence and inference of phylogenetic relationships showed that R. seeberi is
a protist from a novel clade of Parasites that infect fish and amphibians and
R. seeberi is not a classic fungus, but rather the first known human pathogen
from the Drips clade, a novel clade of aquatic protistant parasites2.

Majority of cases are reported from India,
Srilanka and Bangladesh. It has been recognized in many other parts of the
world, like South America, United States, England, Egypt, South Africa

6.
Predominantly male are involved (male to female ratio 4:1).1
It is uncommon in Pakistan4. Mode of transmission is via
water or dust, from which the endospores penetrate the nasal cavity mucosa,
mature into sporangium within the submucosal compartment and after maturation
burst with release of sporangia into surrounding tissue6.
No immune deficiency has been associated with infection1.
Common sites of involvement are nose and nasopharynx. Other sites are larynx,
tracheobronchial tree, esophagus, conjunctiva, ear, bone and skin6.

It usually presents as single or multiple,
pedunculated or sessile masses, pink to deep red in colour, usually described
as strawberry like appearance. They bleed easily with a history of nasal
obstruction or epistaxis. In 1923, Ashworth described in detail the life cycle
of the organism in tissue

The various stages in the life cycle of the
organism may be found in the tissue, but more readily recognizable are the
sporangia in varing stages of maturity and sizes, ranging from 120 to 300
microns in diameter and characterized by an outer chitinous shell with an
inner cellulose wall enclosing thousands of spores

7(Fig
1). Diagnosis is established by observing the characteristic appearance of the
organism in tissue biopsies1. R. seeberi is clearly seen
in hematoxylin and eosin stained section.

The wall of the maturing sporangium and the
spores are stained positively by the Gridley’s technique, periodic acid schiff
(PAS), Gomori methenamine silver (GMS). The condition must be distinguished
from the other polypoid lesions of the nasal cavity